Unlimited Wash Club Cancellation Form

We are sorry to see you go! If you need to cancel your enrollment, please fill out the form below.

Name on the Account*
Cell Phone*
Email*
Plate Number*
Second Vehicle Plate Number (if applicable)
TERMS AND CONDITIONS
As mutually agreed to at the time of enrollment, this form must be received by Cornhusker Auto Wash within at least 5 business days prior to your anniversary date to avoid an additional month of billing. As mutually agreed to at the time of enrollment, early cancellations do not yield a refund and you are entitled to continue with your membership benefits up until your anniversary date.
Digital Signature*
Typing your full name constitutes a digital signature for this enrollment form.
Today's Date*
Date Format: MM slash DD slash YYYY

TERMS AND CONDITIONS